HSE QUESTIONNAIRE

Document Number: HSE-DAM011

Document Type: HSE System/Subsystem: Revised Date: 15/09/16

HEALTH SAFETY & ENVIROMENT QUESTIONNAIRE

Purpose
This questionnaire is designed to obtain your views and opinions about Health Safety and
Environment matters concerning you, your workplace and colleagues.
Please select the response that you think is most appropriate to each statement by ticking. If you wish
to make any comments in addition to these ratings, please do so on the back page.
Statement

Strongly
Agree

Management provides required PPE in a

timely manner

Meetings, trainings, quiz and games carried

out in Damagix actually promotes positive
culture towards HSE.

HSE policies and objectives

understood by employees

Responsiveness of the management on

HSE matter is usually timely and effective.

You have received appropriate emergency

response training

Management encourages the no blame

culture

You have the right tools and resources

needed to do your job safely.

Management recognizes road safety as a

hazardous activity

Management encourages employees to

participate in HSE briefs and trainings.

10

Unsafe acts are reported to punish the

employee who is responsible for the act

11

Are you exposed to various risk and hazard

in Damagix?

12

You have the proper training required to do

your job in a healthy and safety manner?

13

Are Improvement programs supported by

sufficient resources?

14

Has an awareness and

procedure been developed?

15

Management allows opportunities for asking

questions during HSE meetings and

are

well

competency

Agree

No Strong
Feelings

Disagree

Strongly
Disagree

HSE QUESTIONNAIRE

Document Number: HSE-DAM011

Document Type: HSE System/Subsystem: Revised Date: 15/09/16

HEALTH SAFETY & ENVIROMENT QUESTIONNAIRE

trainings.
16

Management has an effective HSE lecture

delivery.

17

Management has good relationship with

new employees on HSE matters.

18

The use of personal protective equipment is

fully implemented

19

Management monitors implementation of

HSE policies via your departmental head

20

Damagix HSE Officers are approachable

and friendly.

21

Management is
employees level.

22

Management provides useful handouts of

notes.

23

HSE Policies, Objectives, Briefs & Trainings

are clear and comprehensible.

24

Management is enthusiastic about HSE

matters.

25

Employee whose work may impact the

environment have been Identified

26

Incidents or near misses are promptly

reported.

27

You have full awareness and understanding

of policies, objectives and improvement
programs

28

HSE committee communicates results of

audits and HSE management review to
employees adequately

29

Damagix has clear documented references

related HSE manual, procedures, work
instructions, etc.

30

HSE
manual
has
been
reviewed,
understood
and
communicated
to
employees (awareness training)

31

There is evidence to suggest that

equipment/procedures (or lack thereof) in
the work environment is not suitable to
achieve the defined targets and objectives

32

Damagix has an emergency drill schedule

able

to

train

at

the

HSE QUESTIONNAIRE

Document Number: HSE-DAM011

Document Type: HSE System/Subsystem: Revised Date: 15/09/16

HEALTH SAFETY & ENVIROMENT QUESTIONNAIRE

33

Damagix takes issues of Nonconformance,

Corrective and Preventive Action serious

34

Damagix has a good system for mitigation

on non-conformance

35

Is there evidence of lack of understanding or

commitment on the part of your
departmental head regarding corrective or
preventive action?

36

Are corrective and preventive actions

implemented adequate to resolve the
incident and prevent re-occurrence?

37

Does Damagix HSE audit gather objective

evidence to draw conclusions?

38

Damagix HSE audit interprets policies and

procedures and determine conformance
with the standard

39

Does Damagix HSE audit checks for

corrective action status including any
Incident Reviews?

40

Are corrective actions are timely, recorded,

and evaluated for effectiveness?

41

Workplace and work practice inspections

and checks are regularly carried out

42

Employees whose work may impact have

been trained on consequences of deviating
from procedure

Reviewed by:

Responder:

Auditors Name:

Date/Sign:

Date/Sign:

Date/Sign: